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As a nurse many people have been wondering what my thoughts are on Ballot Question #1 in the Massachusetts. I think this bill is written up in a way to make you believe you are helping us nurses, but in actuality you are doing us and yourself a disservice. When I first read Question 1, my first reaction was in favor, however the more I read the bill, many concerns came to mind and the more opposed I became.

Question 1 limits the amount of patients assigned to nurses, in hindsight, it sounds like a no brainer, however as a nurse I know without a doubt that NO two nurses, patients or hospitals are the same. This rigid government mandate on nurse staffing ratios is a one size fits ALL Massachusetts hospitals law and although it is very well intended, I believe it is poorly written and it will impact patient safety.

I worry that this new law will actually do more harm than good. I worry about the rushed implementation timeline, if this law is passed, this gives us 37 business days to hire and train enough nurses to meet the mandated ratios. As a preceptor, I know it takes an average of 12 weeks (85 days if you want to get technical) to train a new graduate nurse and an average of 6-8 weeks to train an experienced nurse to a unit. Many argue that there are enough new graduate nurses in MA to fulfill the new mandated ratios, however you need to understand that you need enough time to orient new grads and you need a balance of experienced and non experienced nurses on medical floors. When I was a new grad, I was frustrated when I was not able to get into a hospital staff nurse position fresh out of college, I now know the importance of having experience and the asset it brings to my profession. 37 days is not safe. 

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Mandated staffing ratios will open the door for mandated overtime and mandated floating. Many of us, as nurses feel burnt out at the end of a 12 hour shift, imagine being mandated to stay towards the end of your shift, especially when you have your own obligations and even worse if you are back the next day for another 12 hour shift. Imagine another floor in the hospital is short and you are mandated to float there? To a floor you have no experience in, know nothing about and no one. It could be a similar floor or it could be a floor out of your experienced scope. For example, I work on a general medicine floor, our patient population consists of congestive heart failure, pneumonia, advanced dementia, end stage liver, end stage kidney disease, metabolic derangements, chest tubes, and many other complex illnesses. If another floor is short, I could be mandated to float to a cardiac unit, a urology unit, a thoracic unit, and many other specialty units, to a unit I am not too familiar with and It will put me in an uncomfortable environment and I will feel it is not safe caring for your loved ones and vice versa. Nothing about this feels safe to me.

Question 1 takes away the critical thinking skills of experienced nurses for safe patient assignments and puts it in the hands of this rigid government mandated law. As nurses, we know that patients acuity can rapidly change and this bill does not give us the flexibility to treat it. Every patient's acuity is different, and we are able to switch patient assignments and the work load of our patients if needed. If I have a very sick patient requiring 1:1 nurse care, or a rapid response, a code blue, I know that my other patients are cared for and I can count on the charge nurse to be able to divide my assignment in a safe and effective manner. This bill takes away that flexibility.

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Lastly, many argue that since this law was passed in California, they have had success in patient quality outcomes, however it is NOT the same law, and they had 5 years to implement it. In actuality, Massachusetts is doing better than California on 5 out of 6 nursing-sensitive quality measures. If mandated staffing ratios was the answer, why is it that ONLY 1 state has it?

If question 1 passes, I worry about the prolonged ED wait times, ambulance diversions, units being forced to close off beds because they are not "allowed" to take patients, the mandated overtime, the mandated floating, and most importantly I worry about the safety of my patients, my family and myself whom one day just might be one. 

I am voting NO simply because I know it is not safe. I am voting NO because as an experienced nurse who has worked in a small community hospital and at a large teaching hospital, I know that every patients acuity is different, every hospital is different and every nurse is different. The grand idea has good intentions, however the implementation does not and I fear for those unintended consequences. It is a good idea done badly. To all my nursing friends, we can agree to disagree. I am not saying I don't believe some hospitals and some assignments have worse staffing than others, I am saying this is a great conversation and has brought up so much attention, lets continue to do something about that. This rigid one size fits all bill, is not the way to do it.